Week Ten - Upcoming Surgery.....

We had a doctors visit this week.  We spent a LONG time with the NP, discussing how poorly she is doing (as far as her numbers are concerened), and how at odds that is with how she generally looks.  We refer to her frequently as "the healthiest sick kid you'll ever see."  The NP decided to pull the pediatric surgeon in, since he was seeing other clinic patients, to set up placement of a peritoneal dialysis (PD) catheter.

There are two ways to do dialysis - hemo (blood) or peritoneal (gut lining).  Apparently, kids don't do as well as adults on intermittant hemodialysis, and although it can be set up at home (yeah, you get your own machine and everything!), it is time consuming and requires the patient to sit for a few hours.  Now, me?  Give me a book or a laptop, and I can sit 'til my butt is visibly larger, but Babygirl?  Not so much.

So I think  everybody gets the general idea behind hemodialysis.  They stick a needle in your arm, take out the blood, run it through a machine that cleans it up and put it back.

PD doesn't work this way.  A catheter is permanently inserted through the abdomenal wall.  Then the patient (or family) runs a large amount of clear fluid (2 liters) through the tube into the peritoneal cavity and leave it there for a few hours.  Then the fluid is drained out, by which time it has turned yellow (Voila! Instant Pee!) because the osmotic forces of the fluid content have sucked the toxins out of your blood and into the fluid.  The beauty of this concept is that it can be done at night - fill'er up at bedtime, drain it out in the morning, and off to school you go!

Of course, it's really not that simple.  Now, I have seen tubes that have been placed through the abdomenal wall into the stomach for feeding purposes.  Because of the way they are made, they do not connect to the peritoneal space, and the tract is short and the opening small.  Same with ostomy holes.  But the description of this proceedure gave me the whim-whams. 

The primary incision is in the belly button.  The tube itself, more than a foot long.  Half dangles inside the peritoneal cavity down to the area of the appendix, low on the right side.  The other half is TUNNELED  (ow ow ow thank God she'll be asleep but that baby's gonna hurt when she wakes up!) to the left upper abdomen, near the lower ribs.  The purpose of the tunnel is to prevent peritonitis, infection of the peritoneum, which can lead to so much scar tissue as to make further PD impossible, not to mention that it is, in and of itself, dangerous and very painful.

It takes a month for a PD catheter system to "mature",  She needs it NOW.  But we have swim camp.  And horse camp.  And our annual family beach week, all in a row.  They want her to have what's left of a normal summer.

So surgery is scheduled for August 15.

DeeDee